NEW YORK STATE MUST STOP THE 4/1/25 CARVE-IN OF SCHOOL-BASED HEALTH CENTERS INTO MEDICAID MANAGED CARE
Lawmakers & Advocacy Groups Urge Enactment of Legislation to Protect this Essential Healthcare Safety Net for Underserved Children
[Albany, NY] – Today, Senator Gustavo Rivera and Assemblymember Amy Paulin joined organizations representing school-based health centers (SBHCs), hospitals, health care worker union, and health and education providers and advocacy groups to voice their strong opposition to New York State’s decision to transition SBHCs into Medicaid Managed Care (MMC). Organizations united against the shift urged enactment of legislation that would provide a permanent carve-out of SBHCs from MMC to remain in Fee-for-Service (FFS) Medicaid, S1224, Rivera/ A957, Paulin and S3547, Rivera.
In September 2024, at the direction of Governor Kathy Hochul, the New York State Department of Health (DOH) announced that SBHCs would no longer be paid through Medicaid fee-for-service and would be transitioned to MMC on April 1, 2025. This complicated and costly shift is not feasible in the tightly compressed timeframe dictated by Governor Hochul and is certain to disrupt access to SBHC services in the near term and threatens long term consequences for the survival of this important healthcare safety net.
SBHCs have long provided comprehensive, accessible, and high-quality care to students, particularly in underserved communities. Advocates argue that moving these services, which have always been provided on a fee-for-service basis, into MMC poses significant risks, including reduced reimbursement, added administrative burdens, and disruptions to care delivery. These significant financial and administrative challenges are likely to burden SBHCs into oblivion, undermine access to care, and negatively impact health outcomes for New York’s youth and adolescents. In light of federal funding freezes and uncertainties surrounding Medicaid policies at the national level which are likely to disrupt healthcare delivery, transitioning SBHCs into MMC at this time could further destabilize and limit access to these services. These overlapping threats highlight the shortsightedness of the transition to MMC, which could dismantle the SBHC model in New York State.
The proposed shift is being met with universal resistance from stakeholders directly impacted by the transition, who warn that it could jeopardize access to critical healthcare services for hundreds of thousands of youth across the state. Key stakeholders, including the New York School-Based Health Alliance, Greater New York Hospital Association, New York State United Teachers, 1199SEIU, Medicaid Matters New York, Smile New York Dental, as well as children who directly benefit from SBHC services. All joined lawmakers at the press conference to highlight the widespread opposition to this proposed change. They called on Governor Kathy Hochul to halt the transition and urged the Senate and Assembly to advance legislation to preserve access to these critical preventive, reproductive, mental and dental health care services for the approximately 250,000 children in medically underserved areas who rely on them.
“Protecting access to healthcare for our children is a top priority that must never be compromised,” said State Senator Gustavo Rivera. “My new bill, S3547, aims to codify school-based health centers into statute, regulating how they are established, the procedures they follow, the responsibilities they hold, the services they provide, and would improve the coordination and communication between SBHCs, community-based healthcare providers, and third-party payers. It’s important to highlight that, for many children, this is often their only opportunity to access medical care, and we should not jeopardize it.”
“SBHCs provide care to every child who enters their door, regardless of insurance status or ability to pay, and serve as a critical point of care for the state’s most vulnerable children,” said Assembly Health Chair Amy Paulin. “We must keep SBHCs as Medicaid fee-for-service to ensure both SBHC s’ financial stability, and care for students who may otherwise fall through the cracks.”
“As the mother of school-aged children and the representative in a District that includes 11 schools with this essential wide-ranging service, I understand the value of SBHC’s. Given the uncertainties with Medicaid policies at the federal level, we can ill afford to have children in limbo when it comes to access to immediate healthcare. We simply cannot, in good conscience, allow these children to be marginalized out of a healthy life, an action that could affect them mentally and physically long into the future.” ~Senator April Baskin (D-63)
“School-based health centers are the frontline of care for New York’s most vulnerable children, providing essential health services that families depend on,” said Sarah Murphy, Executive Director of the New York School-Based Health Alliance. “Forcing them into MMC will create chaos and redirect limited resources away from what is most important – caring for New York’s kids. We call on Governor Hochul to avert the crisis this transition will cause and preserve this child-centered model which is essential for providing equitable access to healthcare.”
“School-based health centers, including those operated by GNYHA member hospitals, provide critical primary care services to underserved public school children across the State. These services are provided at no cost to families regardless of their immigration status. The State must adequately fund SBHCs to protect these populations and reverse its decision to carve SBHCs into Medicaid managed care. It imposes a costly administrative burden on these critical safety net clinics, with little to no benefit for the children they serve. GNYHA and our partners urge the Governor and Legislature to protect SBHCs to prevent service reductions and closures,” said Chatodd Floyd, Senior Vice President, Government Affairs, Greater New York Hospital Association.
“School-Based Health Centers are a lifeline for students and families, ensuring that children receive the care they need to thrive in the classroom and beyond. 1199SEIU proudly supports expanding and strengthening these vital services because every child deserves access to quality healthcare, regardless of their zip code or family income. Investing in SBHCs is an investment in our future, said 1199SEIU WNY Vice President, Jim Scordato.
“Students must continue to have access to health care, dental care, and mental health care through school-based health centers. We often talk about meeting people where they are, and school-based health centers do just that to provide quality care and services to children and adolescents across our state. Adding the administrative layer of managed care would threaten access to care for young New Yorkers.” said Lara Kassel, Campaign Coordinator, Medicaid Matters NY.
“With less than 60 days until the planned transition of SBHCs into MMC, this unworkable and reckless shift sets these critical providers up for failure. SBHCs and their sponsoring organizations cannot reasonably be expected to negotiate and finalize contracts with all of the state’s managed care plans, let alone credential all providers in under 60 days. The administration is forging ahead with this drastic and shortsighted shift despite significant outstanding issues and a complete lack of feasibility that is certain to decimate access to this critical point of healthcare for underserved children in New York. We urge Governor Hochul to reconsider this decision and the State Legislature to advance the legislation to keep SBHCs in FFS,” said Murphy.
